Disorders of the Pleura: Disorders of the Pleura |

Characterization of Patients With Complicated Parapneumonic Pleural Effusions FREE TO VIEW

Maria Velez, MD; Stephanie Levine, MD; Mudassar Ahmad; Reyes Luis; Marcos Restrepo
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UTHSCSA, San Antonio, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):563A. doi:10.1016/j.chest.2016.08.652
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SESSION TITLE: Disorders of the Pleura

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: To describe the characteristics of patients with Parapneumonic Pleural Effusions (PPE), including: demographics, presenting findings , Pleural Fluid ( PF) characteristics,management and outcomes at two tertiary teaching institutions

METHODS: This is a retrospective cohort study evaluating the processes of care delivered at 2 teaching institutions between January 1, 2007 and January 31, 2015 We Included adult patients with diagnosis of complicated PPE confirmed by pus obtained by aspiration, positive gram stain, PF LDH >1000, pH<7.2, Glucose <60 mg/dl or multiple loculations on imaging. We excluded patients with effusions secondary to trauma, surgical procedures, hospital-acquired pneumonia, malignancies and Mycobacterium tuberculosis infection Data analysis performed using SPSS

RESULTS: We identified 71 patients with mean age of 50 years ( 25-85), 76% males. The most common type of pneumonia was CAP (79%) and presenting symptoms cough (83%), pleuritic chest pain (64.8%) and fever (62%). 24% of patients were admitted to ICU and 70% of these required mechanical ventilation. Most common characteristics of PF were pH < 7.2, Glucose < 33 mg/dL, LDH > 928 U/L and WBC > 1000/µL. Gram stain was positive in 28.2%, and 44% had positive PF cultures. Most common organisms were Streptococcus anginosus (32%), MRSA (22%) and anaerobes (13 % ). 20% had positive blood cultures and 36% positive sputum cultures 89% of patients required chest tube placement ( 80 % small bore-14F or less-) . 47% received intrapleural TPA with achievement of clinical cure (CC) in 61%, 17% intrapleural TPA + DNAse with CC in 73% , and 19 % required surgical intervention. .71 % required 3 procedures or less to achieve CC The mean length of stay was 14 days (4-39). Inpatient mortality was 1.4% and readmission rate within 90 days of discharge was 27%

CONCLUSIONS: This is a large study that describes several important characteristics and clinical outcomes of patients admitted to our teaching institution with the diagnosis of complicated PPE

CLINICAL IMPLICATIONS: Complicated PPE are a common clinical entity with important implications such as prolongued hospital stay, high morbidity and increased healthcare costs , understanding the characteristics of the patients admitted to our institutions with this diagnosis gives us the opportunity to identify areas of improvement in the care of these patients , formally protocolize our processes of care and perform subgroup analysis to identify patient characteristics predictive of outcomes and response to management

DISCLOSURE: The following authors have nothing to disclose: Maria Velez, Stephanie Levine, Mudassar Ahmad, Reyes Luis, Marcos Restrepo

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